Do you sit or squat? Toilet-makers in South Asia need to ask this question

It’s time for a toilet break.

One of the problems poor people face in this part of the world is that they don’t have toilets or clean water. Language here starts getting complicated pretty quickly – the Millenium Development Goal on environment refers to “basic” and “improved sanitation”. One of the things that this is saying is that not everyone needs to have their own personal toilet – they might share with other families – but we really don’t want them “practicing open defecation”, or shitting out in the open. That’s bad for them and for people in the same community.

There’s a lot of back and forth about this. Bill Gates is personally reinventing the toilet. A UK government project in Bangladesh (that I used to work for) has built toilets for over 140,000 people. Basically, building people toilets is one of the key things that international development work does.

Except that not everyone can use the toilets after they’ve been made. Here’s a great report from Nepal. It’s from 2004, but still rings true:

Latrine designs are often made by male engineers who do not have to use the latrines. The designs are drawn up in offices far away from communities without any consultation with the broad range of end users and therefore designers are not aware of the difficulties faced by certain categories of users.

From Making Latrines User Friendly for Everyone by Nepal Water for Health.

What they found out is that when they talked to people, and women especially, the toilets that they’d been making had a bunch of problems. These problems hadn’t come out because they didn’t ask what users needed. Thousands – or hundreds of thousands – of latrines had been made with the same design. For me, the one-size-fits-all approach is a key reason that development work finds disability inclusion hard.

A mother and son stand in front of a white latrine. There are two steps to enter, where there is a squat-toilet.

This photo is from Habitat for Humanity, of a latrine they built in Bangladesh. Hopefully it’s fine for this family — but this design wouldn’t work for everyone.

In this case the one-size-fits-all solution were squat toilets. Users didn’t have anything to grab onto and the foot rests were easy to slip off of. Another common issue in Bangladesh is that toilets are raised and have steps to go in. In the research from Nepal, people who were pregnant, elderly, or sick all reported problems with the standard design of latrine. One or two disabled people were interviewed as well, but the study shows that the typical design wasn’t working even for people without obvious disabilities.

There are plenty of other issues with toilets, not to do with how you sit on them. The people I know who work on sanitation issues are particularly concerned with disposal of faeces, as often there isn’t a connection to a sewage supply. In its piece on Sanitation in India, The Economist points out that cultural practices might be a limitation too. And who empties the pit when it’s full? And how do you get the local and national branches of government to put systems into place?

All of these are really key questions. But business-as-usual is failing people right now by continuing to make toilets they can’t use. We know what the solutions are. Some of it is a bit of technology – a grab-bar hear, or a temporary seat, or a western commode. I’ve seen people use ropes for support, as well. And beyond the technology, too: you need user input, shared information and awareness of these issues too. When we work on sanitation we need to ask ourselves difficult questions about who’s being left out by what we do.

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